Level of Depression, Criminogenic Cognition, Relapse Risk, and Quality of Life among Patients with Substance Use Disorders

and other substance use disorders (O-SUDs) experience psychosocial problems that affect their quality of life (QOL). Objective: To determine the difference in depression, criminogenic cognition, relapse risk, and quality of life between patients with OUD and O-SUDs. Methods: In this cross-sectional study, the sample was collected from different rehabilitation centres in Faisalabad and Lahore. A purposive sampling technique was used to collect data from individuals with OUD (150) and O-SUDs (150) with relapse conditions through Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), Criminogenic Cognition Scale (CCS), Patient Health Questionnaire-9 (PHQ-9), Relapse Risk Scale (RRS) and WHO Quality of Life (WQOL). The collected data were prepared for statistical analysis using SPSS, Version-26. Results: The �nding shows a signi�cant difference between patients with OUD and with O-SUDs on the variables of PHQ-9, short-term orientation, negative attitudes toward authority, notions of entitlement, failure to accept responsibility, insensitivity to the impact of crime, and criminogenic cognition. In addition, a signi�cant difference was found between patients with OUD and with O-SUDs on anxiety problems, positive expectancies and compulsivity, abstinence violation effect, low self-ecacy, relapse risk and QOL. Conclusions: It is concluded that depressive symptoms, criminogenic cognition, relapse risk conditions, and quality of life were higher among patients with OUD than patients with O-SUDs.


Original Article
Substance use problems (SUDs) have been noted in the literature throughout the ages [1].Opioid use disorder (OUD) is a major public health concern because of its destructive effects on physical and mental health [2][3][4].An individual who uses opioids develops tolerance and it is a person's response to a medicine diminishes with time demand for a higher dose to attain the same effect as it did at rst [5].Relapse is a common and formidable challenge in SUD treatment.Approximately 60% of patients with OUD relapse after inpatient psychological treatment because of their signs and symptoms [6].The most common signs and symptoms are loss of control over opioid use, continual opioid use, disdain attempt to cut down, and having occurring conditions can create a synergistic effect, leading to adverse consequences such as Criminogenic cognition and behavior.Criminal behaviors associated with using opioids can take various forms, including drug tra cking, theft, and fraud to obtain funds for purchasing drugs [16,17].These legal consequences can have a lasting impact on one's QOL.Criminal behaviors affect physical health and have profound implications for mental, emotional, and social well-being [18].However, this study showed that opioid use disorder encompasses a diverse range of conditions, each with its unique impact on variables such as depression, criminogenic cognition, relapse risk, and quality of life.By understanding these distinctions is effective for developing effective strategies and support systems that cater to the speci c needs of individuals struggling with various types of substance use disorders.By considering these differences, we can work towa rd s m o r e c o m p a ss i o n a te, ev i d e n c e -b a s e d approaches to addiction prevention, treatment, and recovery, ultimately aiming for improved outcomes and well-being for those affected by OUD.

M E T H O D S
used psychoactive drugs.The ASSIST collects data on a user's lifetime substance use, recent substance use (within the past three months), substance-related di culties, risk of harm (both immediate and long-term), dependency, and injectable drug usage.It consists of 8 items.Item 1 is further with 10 items which are based on the answers of yes or no [20].Construct validity of this scale is (r = 0.76).Criminogenic Cognition Scale (CCS): CCS is a 25-item selfreport measure designed to tap ve dimensions: Notions of entitlement; Failure to Accept responsibility; Short-Term Orientation; Insensitivity to Impact of Crime; and Negative Attitudes Toward Authority.Items ranged on a 4point scale with 1-4 as strongly disagree to agree strongly.Items 10, 17, and 20 are reversed scoring.All ve subscales were signi cantly correlated with full-scale scores (r = .65 to .43).Patient Health Questionnaire (PHQ-9: It is a depression screening instrument that can be selfadministered [21].The PHQ-9 includes all 9 diagnostic symptom criteria, including the two cardinal signs of depression: anhedonia and depressed mood subjects are asked to rate how often they have "been affected by any of the following di culties in the past two weeks" using the PHQ-9.The scoring showed four categories of depression, such as None, mild, moderate, severe and extreme (20-27) depression are indicated by the scores.The PHQ-9 had a Cronbach's alpha of 0.91.Relapse Risk Scale (RRS): Relapse Risk Scale (RRS), is a 44-item self-report measure to identify relapse risk among individuals with substance use disorder [22].This scale has four dimensions: First: Low Self E cacy.Second: Abstinence Violation Effect (items: 3, 5, 8, 9, 12,15,18,22,24,28,29), Third: Anxiety Problems.Fourth: Positive Expectancies and Compulsivity to use drugs, containing.It is a 5-point Likert-type rating scale from 'strongly agree' (5), 'agree' (4), 'undecided' (3) to ' disagree' (2) and 'strongly disagree' (1).The scale showed an alpha coe cient of .95.World Health Organization Qualityof-Life Scale (WHOQOL): Patients with SUDs have veri ed its e cacy [23].The WHOQOL-BREF is a self-reported scale with a total of 26 items.Items 3 through 26 cover the four domains of quality of life: physical, mental, social and environmental.These are graded on a Likert scale from 1 (completely unsatis ed) to 5 (completely satis ed), with item 3 being backwards coded.All areas of the instrument showed a reliability between.67 and.86.In this study, all procedures were approved by the Institutional Review Board (IRB) of Government College University, Faisalabad.In this study, a Sample of N=300 participants diagnosed with opioid use disorder and poly-drug users with relapse conditions from the different hospitals, rehabilitation centres, and primary care clinics of Faisalabad and Lahore were taken to investigate the differences in the variables on depression, criminogenic cognition, relapse risk and In this study, cross-sectional research design was used.The sample was collected from different rehabilitations centres and we used purposive sampling technique to collect the data.Initially, the sample of N=300 participants were diagnosed with OUD (150) and O-SUDs (150) with relapse conditions we recruited after getting consent from the participants.Participants they have history of drug addiction with relapse condition and currently they are under treatment were investigated from the different hospitals, rehabilitation centres, and primary care clinics of Faisalabad and Lahore in 06 months through purposive sampling technique.The patient's age range was between 20 to 65 years.Patients were taken from any marital status and socioeconomic status.Participants would be diagnosed according to the DSM-V-TR.Participants with more than 4-time history of relapse and more than 5 years of history of illness were omitted from the study.Participants with different medical and psychological conditions were excluded.Demographic form: A demographic form would be used to take information, i.e., patient age, education, family system, socioeconomic status, marital status, total number of family members, employment status, etc.The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) [19].It's a quick quiz to see if someone has ever experimented with or quality of life between opioid use disorder and other substance use disorders [24,25].After completion of the data, all data were scrutinized and scored according to the manuals and measurement guidelines.The data were transferred to SPSS, and all the computation was calculated through SPSS-version 26.0.The nding shows a signi cant difference between patients with OUD and with O-SUDS on the variable of PHQ-9.Similarly, a signi cant difference was estimated between patients with OUD and with O-SUDS on the variables of Criminogenic Cognition, Relapse Risk Scale and QOL (Table 2).QOL: Quality of life; PHY: Physical; PSY: Psychological; ENV: Environment; SOC: Social Findings show signi cant mean difference was investigated between single and married individuals in the variable of PHQ, RRS and QOL and insigni cant difference was found on the scale CSS (Table 3).

D I S C U S S I O N
The study aimed to determine the difference in depression, criminogenic cognition, relapse risk, and quality of life Note: p<.001, PHQ: Patient Health questionnaire; CCS: Criminogenic Cognition Scale, RRS: Relapse Risk Scale, QOL: Quality of life Findings showed signi cant mean difference was investigated between patients with nuclear and joint family system in the variable of PHQ and CCS and insigni cant difference was found on the scale RRS and QOL (Table 4).Note: p<.001, PHQ: Patient Health questionnaire; CCS: Criminogenic Cognition Scale, RRS: Relapse Risk Scale, QOL: Quality of life Findings reported that signi cant difference was found among all groups on the scale of PHQ, CCS, RRS and QOL among patients with substance disorders.Furthermore, group comparison statistics showed that unemployed participants were found signi cantly different from employed and businessmen while insigni cant difference was calculated between employed and businessmen on the scale of PHQ, CCS, QOL and RRS (Table 5). .As well, the nding of the current study also showed that marital status, family system and economic status are critical factors in the development of maladaptive behaviours such as drug addiction.The result supported that higher rates of SUDs for unemployed people, as compared to employed people [1,39].Other study also con rmed that substance related deaths were more frequently found among the unemployed [40].The result is similar to previous literature that unmarried people are signi cantly high than married individuals to develop SUDs [41].Among the participants, 83.38% reported being single when they rst started using drugs, 12.14% were married [42].Similar study, conducted being single may in uence continued heavy alcohol use and moderate and heavy mar uana use [43].
It is concluded that depressive symptoms and relapse risk conditions were higher among patients with OUD than patients with O-SUDs.Moreover, the level of criminogenic cognition and quality of life were higher in O-SUDs as Conceptualization: MS, KM Methodology: MS, KM Formal Analysis: MS, KM Writing-review and editing: MS, KM

Table 1 :
Demographic characteristics of the sample

Table 2 :
Mean difference in the variable of depression, criminogenic cognition, relapse risk, and quality of life between patients with opioid use disorder and other substance use disorders Note: p<.001; OUD= Opioid Use Disorder; O-SUDs= Other-Substance Use Disorders; PHQ: Patient Health questionnaire; CCS: Criminogenic Cognition Scale; NOE; Notions of entitlement; FAR: Failure to Accept Responsibility; IIC: Insensitivity to Impact of Crime; NAT; Negative Attitudes Toward Authority; STO; Short term Orientation; RRS: Relapse Risk Scale; PEC: Positive Expectancies and Compulsivity; AVE: Abstinence Violation Effect; ANP: Anxiety Problems; LSE: Low Self E cacy;

Table 3 :
Mean difference in the variable of depression, criminogenic cognition, relapse risk, and quality of life between single and married patients with opioid use disorder and other substance use disorders Note: p<.001, M= Mean, SD= Standard Deviation, MS= Mean Square, U=unemployed, E= Employed, B= Businessmen, PHQ: Patient Health questionnaire; CCS: Criminogenic Cognition Scale, RRS: Relapse Risk Scale, QOL: Quality of life

Table 4 :
Mean difference in the variable of depression, criminogenic cognition, relapse risk, and quality of life between nuclear and joint family system patients with opioid use disorder and other substance use disorders

Table 5 :
ONE-ANOVA statistics on the scale of PHQ, CCS, RRS and QOL among unemployed, employed and businessmen in patients with opioid use disorder and other substance use disorders Furthermore, it was also revealed that people with OUD experienced relapse risk.Prior studies have also provided evidence that the risk of relapse to OUD is high[31].Other research also concluded that individuals with OUD relapse due to nonmedical use of opioids[32][33][34].Relapse was more likely when more than one of these risk variables was present, as was a history of relapse[35].Moreover, this study concluded that QOL affect those individuals who use all substances other than OUD.Consistent with previous ndings that physical QOL is affected by opioid use disorder[36, 37].Reduced QoL is recognized as a negative result connected with SUDs and both sleep issues and SUDs can have detrimental effects on one's physical and mental health[38]